Ethics Corner: Ethical Issues in the Use of Social Media

James W. Roach, MD
Ethics and Professionalism Committee Chair

Social media is broadly defined as communicating with others using electronic medium through a computer, tablet, or phone. This technology has greatly expanded the various ways people can interact with one another. Using social media technology, individuals can easily communicate with friends, family, and co-workers in an almost immediate manner. Because this provides such incredible efficiency and accessibility, multiple forms of social media have been fully embraced by society, especially the younger generation. The use of social media does present certain concerns especially for physicians. However social media is merely a form of communication and the standards for professional behavior should remain consistent across all the various interactions between physicians and patients. The hallmark of professional behavior is maintaining patient trust and confidentiality. The remainder of this article summarizes the conclusions reached by the policy statement from the American College of Physicians and the Federation of State Medical Boards regarding physician use of social media.1

Physicians have the opportunity to use social media in several different ways. The most obvious is for clinical purposes and there are four general ways to use social media in this manner.

Direct Patient Care
The speed of communicating directly with patients about specific medical questions is very appealing and if properly implemented, can improve the patient/physician relationship. Since this communication is outside of the electronic medical record, many privacy issues can occur. Physicians who offer this type of direct patient communication should establish an agreement with the patient covering how the information will be transmitted, the type of healthcare information that will be imparted, the expected response time, the possibility of loss of confidentially, and the requirement that the patient also maintains face to face follow up visits. In addition the physician should consider the possibility that an electronic message which crosses state lines could violate state licensing requirements.

Examples of this type of direct patient care communication would be email, texting, and instant messaging. Misunderstanding the presented information is a major risk with non-face to face interactions and shorter messages probably increase this risk. The use of email through a secure, protected server is preferable with the less secure texting and instant messaging more compromised as a form of communication. Most medical institutions host encrypted sites that permit safe email communication with patients. In addition these sophisticated networks often have mobile device management systems to disable phones, tablets, or computers that become lost or stolen.

Providing Valid Medical Educational Information (Not Direct Patient Care)
Physicians can also develop electronic mechanisms to share valid medical information with individuals who may or may not be current patients. Typically a physician will develop a website which has links to a medical society or a specialty association website where the medical information is reliably peer reviewed. This is a significant benefit to individuals who seek reliable medical information. However the physician is responsible to vet the content and refer patients to reputable sites. Information on a physician’s website also must be truthful and accurate. Claims of treatment outcomes that are untruthful, misleading, or deceptive are illegal as they would violate the FTC Act (15 U.S.C. Sect. 45), truth in advertising. Statements on a physician’s website that use the phrases “painless”, “safe” or “effective”, “cure”, and “bloodless” are especially concerning. Likewise hyperbole regarding a physician’s qualifications and using terms such as “world famous”, “top surgeon”, and “pioneer” are best avoided. The SRS wants all members to interact truthfully and honestly in all situations.

Interacting With Medical Colleagues
Physicians use electronic means to discuss medical issues with colleagues. These are usually sites maintained and secured by medical or specialty societies. Postings then attract comments and suggestions from the other society members. This is a secure and proper way to seek advice from other colleagues. Posting on unsecure sites is best avoided.

Public Blogs Focused on Medical Issues
There are multiple public sites were medical issues are discussed. These are not secure and individual healthcare information should never be included in any communications on these sites. In many instances these public blogs drift far afield of the original issue and become forums for venting by ranting, unhappy people. A physician comment on a public blog is likely retrievable and may be embarrassing if the blog’s subsequent commenters stray into an inappropriate discussion. Avoiding these sites is probably prudent.

Non-medical Social Media
Physicians can also participate in social media in a purely personal manner. Examples of these social media venues would be Facebook, YouTube and Twitter. While many physicians participate on these sites it is best to keep personal information private and not “friend” patients. This is especially in case when pictures are included that might be misunderstood by the public, cell phone photos in the OR are sent, or a medical skit is uploaded to a video site. The public does not always interpret medical humor as harmless. Posted comments on social media can now be indexed by Google, permitting indiscretions to live forever.

The “contract” between physicians and the public centers on professionalism and the physician is expected to maintain high ethical standards and not display poor judgment. An individual physician who does something inappropriate will suffer the public’s negative impression but unfortunately the physician’s action also diminishes society’s trust in the entire profession.